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Friday April 25, 2025 9:10am - 9:25am EDT
Title: Optimizing Outpatient Antibiotic Therapy: Impact of Continuous Infusion Beta-Lactams and Vancomycin on Patient Adherence and Clinical Outcomes
Authors: Tarik Prince, Tyler Martin, Geren Thomas, Megan Mills
Objective: To compare the impact of continuous infusion (CI) versus intermittent infusion of beta-lactams and vancomycin in outpatient parenteral antibiotic therapy (OPAT) on patient adherence, clinical outcomes, and device-related complications, while assessing potential advantages of CI based on pharmacokinetic/pharmacodynamic principles.
Self-Assessment Question: How does continuous infusion (CI) of beta-lactams and vancomycin in OPAT compare to intermittent infusion in terms of patient adherence, clinical outcomes, and device-related complications? Provide at least one potential advantage of CI based on pharmacokinetic/pharmacodynamic principles.
Background: Beta-lactam antibiotics are widely used globally, and their bactericidal activity depends on optimizing pharmacokinetics by maximizing the fraction of time their concentration exceeds the minimum inhibitory concentration (fT>MIC). Continuous infusion (CI) over 24 hours has been demonstrated to improve fT>MIC, potentially leading to enhanced bacterial eradication, reduced resistance development, and lower relapse rates compared to intermittent infusion. While robust data exist for inpatient settings—showing reduced mortality, shorter hospital stays and improved clinical cure rates—the impact of CI in outpatient parenteral antibiotic therapy (OPAT) remains underexplored, especially concerning patient adherence and clinical outcomes. This study investigates CI versus intermittent infusion of beta-lactams and vancomycin in OPAT, focusing on treatment success, adherence rates, and device-related complications such as catheter occlusions and infections.
Methods: This prospective, quasi-experimental study evaluated patients discharged on CI antibiotics versus intermittent dosing. Inclusion criteria included adults (≥18 years) receiving OPAT with beta-lactam antibiotics for infections requiring prolonged therapy. Stability data for beta-lactams and vancomycin administered via CI through elastomeric devices were reviewed for compatibility with 24-hour CI. A dosing protocol was developed, detailing drug preparation, concentrations, device use, and patient monitoring. Patient adherence was assessed through self-reports (documenting missed doses), shipment tracking (confirming on-time medication delivery), and provider follow-ups (verifying compliance with administration schedules). Adherence was defined as 100% of prescribed doses received without missed or delayed doses. Secondary outcomes include clinical response, adverse effects, and hospital readmission rates within 30 days post-treatment completion. Data will be analyzed descriptively, with logistic regression for adherence predictors.
Results: An interim analysis was conducted, including six patients in the intermittent infusion group. The mean age was 71 years (range 51–90 years), with 67% of patients being male. The infections treated included osteomyelitis, urinary tract infection, Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia, pneumonia, MSSA wound infection, and Pseudomonas aeruginosa wound infection. Adherence rates were 67%, with four patients adhering to therapy. Clinical response was achieved in 66% of patients, with no readmissions within 30 days post-discharge. Despite non-adherence in two patients, both achieved clinical cure. The most notable adverse event was a rash, which prompted a change in therapy.
Conclusion: No definitive conclusions can be drawn at this time due to the small sample size and data available only for one arm of the study. Given the limited sample size, further research with a larger cohort is needed to explore factors influencing adherence and its potential impact on clinical outcomes. Data collection is ongoing for both the intermittent infusion and continuous infusion groups, and additional retrospective data may be required to strengthen these findings.
Moderators 
Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
PGY-1 Pharmacy Resident, Archbold Memorial Hospital
My name is Tarik Prince, and I am a PGY1 Pharmacy Resident at John D. Archbold Memorial Hospital in Thomasville, GA. I earned my Doctor of Pharmacy degree from Mercer University, and my primary interests lie in emergency medicine, critical care, and antimicrobial stewardship.My research...
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PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree...
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Friday April 25, 2025 9:10am - 9:25am
EDT
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